What is a psychotic disorder?

Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality i.e. seeing, hearing and believing things that are not real, and often are unable to meet the ordinary demands of daily life.

How many people have it?

Approximately 3 in 100 people will experience an episode of psychosis during their lives or about 1% of the population worldwide suffers from psychotic disorders.

What are the symptoms of psychosis?

  • Hallucinations: apparent perception of something not present, i.e. perceiving things that are not real or present for sensation or perception at the current time. It can be auditory, visual, tactile hallucinations, e.g.: seeing things that are not being seen by others or hearing things that are not heard by others at that point in time.
  • Delusions: false beliefs that a person holds on to, without adequate evidence.
  • Catatonia: does not move or interact with the world around in any way while awake or excessive purposeless motor movement.
  • Thought disorder: an underlying disturbance of conscious thought.

The following behavioural signs can be seen –

  • A tremendous drop in grades or job performance that worries family, friends and colleagues.
  • Difficulty thinking clearly, confusion, difficulty in concentration, jumping from one thought to another.
  • “word salad”, persons show loosening of associations, that is, a disconnection and disorganization of the semantic content of speech and writing
  • Suspiciousness or uneasiness with others.
  • Cold, detached manner with the inability to express emotion
  • Mood swings or other mood symptoms, such as depression or mania
  • A decline in self-care or personal hygiene.
  • Loss of interest in activities
  • Spending a lot more time alone than usual.
  • Strong, inappropriate emotions or having no feelings at all.

What are the different types of psychotic disorders?

  1. Schizophrenia: it is a disorder involving the above mentioned hallucinations and delusions that persists for more than 6 months. During this period the individual drifts away from reality perceiving and believing in things that are otherwise not real. It leads to dramatic problems in the areas of work, personal relations and even hygiene. There is a tendency to withdraw from life as it was to the person before and get deeply involved in a fantasy world perceiving it as reality. Cognitive functioning and the experience of reality is distorted. There are positive and negative symptoms. The positive symptoms include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations. The negative symptoms are flat expressions, little emotion or inappropriate emotional expressions, lack of speech, inability to experience pleasure, lack of desire to form relationships, and lack of motivation. Negative symptoms appear to be more responsible for poor quality of life in people with schizophrenia. The cause can be genetic predisposition, developmental, neurological or even environmental. Psychiatric help should be immediately given; hospitalizations may be required in some cases. Counselling can be given when the individual is showing negative symptoms. Counsellingfamily members are also required helping them take care of the individual with the disorders as well as of themselves.
  2. Schizoaffective disorder: People with this illness have symptoms of both schizophrenia and a mood disorder i.e. disrupted thought process and emotions, such as depression or bipolar disorder. But does not qualify for the diagnosis of schizophrenia or a mood disorder alone. Symptoms include delusions, hallucinations, disorganized speech, thinking or behaviour and negative symptoms and mood symptoms are of mania, hypomania, mixed episode, or depression, and tend to be episodic rather than continuous. Causes can be both genetic and environmental. Treatment involves medication, psychotherapy, family therapy and electroconvulsive therapy.
  3. Schizophreniform disorder: People with this illness have symptoms of schizophrenia, but the symptoms last between one and six months.
  4. Brief psychotic disorder: People with this illness have sudden, short periods of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick — usually less than a month.
  5. Delusional disorder: People with this illness have a delusion (a false, fixed belief) involving real-life situations that could have a potential to be true but there is no evidence that it is, such as being followed, being conspired against, or having a disease. These delusions persist for at least one month. It does not involve prominenthallucinations, thought disorder, mood disorder, or significant flattening of affect.
  6. Shared psychotic disorder (also called folie à deux) : This illness occurs when one person in a relationship has a delusion that the other person in the relationship adopts for him or herself.
  7. Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from some substances, such as hallucinogens and crack cocaine, that may cause hallucinations, delusions, or confused speech.
  8. Psychotic disorder due to a medical condition: Hallucinations, delusions, or other symptoms may be the result of another illness that affects brain function, such as a head injury or brain tumor.
  9. Paraphrenia: This is a type of schizophrenia that starts late in life and occurs in the elderly population.
  10. Menstrual psychosis – It is a form of psychosis with a brief, sudden onset related to the menstrual cycle. The symptoms can be dramatic and include delirium, mania or mutism. They generally resolve fully. It is very rare.
  11. Postpartum psychosis, occurring recently after childbirth. Postpartum psychosis also called puerperal psychosis covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth.
  12. Occupational psychosis: it is the concept that one’s occupation or career makes that person so biased that they could be described as psychotic. Especially common in tight occupational circles, individuals can normalize ideas or behaviours that seem absurd or irrational to the external public.
  13. Tardive psychosis: it is a form of psychosis distinct from schizophrenia and induced by the use of current (dopaminergic) antipsychotics by the depletion of dopamine and related to the known side effect caused by their long-term use, tardive dyskinesia.
  14. Cycloid psychosis: it progresses from normal to full-blown usually within a few hours, not related to drug intake or brain injury. Diagnostic criteria include confusion, mood-incongruent delusions, hallucinations, pan-anxiety, a severe anxiety not bound to particular situations or circumstances, happiness or ecstasy of high degree, motility disturbances of akinetic or hyperkinetic type, concern with death, mood swings to some degree, but less than what is needed for diagnosis of an affective disorder. It occurs in people of generally 15–50 years of age.
  15. Secondary psychosis:A very large number of medical conditions can cause psychosis, sometimes called secondary psychosis

Comorbidity of psychosis can be found with the following disorders

  • 40% with depression
  • 60% with anxiety
  • Substance use: individuals with severe psychotic disorders have increased risks for smoking (odds ratio, 4.6; 95% CI, 4.3-4.9), heavy alcohol use (odds ratio, 4.0; 95% CI, 3.6-4.4), heavy marijuana use (odds ratio, 3.5; 95% CI, 3.2-3.7), and recreational drug use (odds ratio, 4.6; 95% CI, 4.3-5.0).
  • Schizophrenia
  • Bipolar disorder
  • Obsessive compulsive disorder
  • Post-traumatic stress disorder

What causes psychotic disorder or psychosis?

    • Several factors can contribute to psychosis:
    • Psychiatric disorders – it is difficult to distinguish if psychosis is caused by psychiatric disorders like bipolar disorders or depression or it is a psychiatric disorder in itself.
    • Psychoactive drugs – Various psychoactive substances (both legal and illegal) have been implicated in causing , exacerbating, and/or precipitating psychotic states and/or disorders in users. This may be upon intoxication, for a more prolonged period after use, or upon withdrawal
    • Genetics – Many genes are associated with the development of psychosis, but just because a person has a gene doesn’t mean they will experience psychosis. Studies are still being conducted to determine the exact genes that cause psychosis.
    • Trauma – A traumatic event such as a death, war or sexual assault can trigger a psychotic episode. The type of trauma (as well as a person’s age) also affect whether a traumatic event will result in psychosis.
    • Substance use – The use marijuana, LSD, amphetamines and other substances can increase the risk of psychosis in people who are already vulnerable.
    • Medical conditions (Physical illness or injury) – Traumatic brain injuries, brain tumors, strokes, HIV and some brain diseases such as Parkinson’s, Alzheimer’s and dementia can sometimes cause psychosis.

What is the age of onset of psychotic disorder?

There is no specified age of on set for psychotic disorders. Genetics interact with the environment for a disorder to set in which can happen at any age.

How to prevent psychosis?

Early detection and treatment is very important

      • Say no to illegal drugs. Research proves that cannabis users are at 40% more risk of developing psychotic disorders than non-cannabis users.
      • Avoid excessive alcohol.
      • Legal drugs, medicines to be taken only by prescription under the supervision of a doctor. Addictions to legal or illegal drugs are to be avoided.
      • Taking immediate and proper help after the experience of traumatic situations and not letting it go unattended.
      • Taking proper care for medical conditions.

Experiencing prolonged bouts of stress can sometimes trigger an episode of depression. Both stress and depression are major risk factors for psychosis. Therefore preventing stress and depression can also help in preventing psychosis. Taking on time professional help for both can be helpful.

How to treat psychosis?

Medication + psychotherapy

Hospitalizations and Electroconvulsive therapies may also be required depending on the severity/intensity of the present situations.

It is the people suffering from psychosis who are commonly called “MAD” by the general ignorant people around them and there have been various forms of media depiction of psychosis as well, this has created a lot of myths and fears in the minds of the people about psychosis and its types. However it is advisable to take professional help in case of any individual believed to be suffering from psychosis or feels is on the verge of developing disturbances that he/she is unable to understand or when the family feels apprehensive about the behaviour of their loved ones. Treatment when done with understanding and support from loved ones can guide the person through a path of recovery leading to a successful symptom free future.

We at Mumbai Psychiatry Clinics have a dedicated team of counsellors and clinical psychologists who will help you with your problems, cite interventions and assess the progress on regular intervals. There are experienced psychiatrists who will be guiding you throughout your journey and our Multidisciplinary team will try to assure you with the best help possible.